Who is the best candidate for invasive treatment in the GERD population?
The line between aggressive, invasive care for gastroesophageal reflux disease (GERD) is very fine, and often depends on the patient demographic. While younger patients more capable of recovering fully from invasive care are considered good candidates, it's an option that needs to be given to every patient within scope of medication risks.
In an interview with MD Magazine®, Amy Tyberg, MD, assistant professor, associate director of Endoscopy, and director of Therapeutic EUS at the Rutgers Robert Wood Johnson Medical School, explained how she approaches the variable treatment process with all of her patients, and what's often more treatable with medication.
MD Mag: At which point is an interventional procedure or surgery an option for treating GERD?
Tyberg: I think, you know, the decision whether to proceed with something more invasive or stick with medications is a very personal decision and is very patient dependent. I have a conversation with every patient who has reflux, about the risks of every intervention, every treatment therapy that there is.
What I find is that there's an increasing number of patients who are hesitant to be on medication indefinitely. I say that it's now sort of the trendy thing in medicine to come out with another side effect related to the PPI class of medications. You know, they're wonderful medications, but there's an increasing number of people that are nervous about the risks associated with them—rightly so, I think.
And certainly, younger patients who have years ahead of being on these medications are good candidates for something more invasive. Or patients that are just not getting a full response, or have lost their response to the medication over time—those are the patients that generally opt for something a little bit more invasive, either the endoscopic procedure, or the surgical intervention for reflux.
MD Mag: What are the best options for treating GERD-related symptoms? Which symptoms are most common?
Tyberg: You know, I think the classic heartburn symptoms generally respond very well to medications. Probably the most difficult to treat is regurgitation, and I don't think we know exactly why. But that seems to be one of the most difficult to control especially with just medication alone, but certainly, these other procedures (including TIF 2.0 procedure with EsophyX Z) are pretty effective at treating all symptoms of reflux across the board.